Abstract 14649: Association of P Wave Indices with Atrial Fibrillation and Mortality Risk in the Community: the Framingham Heart Study
Background: Long-term risk prediction is a priority for prevention of atrial fibrillation (AF). P wave indices (PWI) are non-invasive, electrocardiographic measurements reflecting atrial conduction, and their association with AF or mortality risk has had limited assessment.
Methods: We quantified by digital caliper the PWI of maximum duration and dispersion in 1,550 Framingham Heart Study participants ≥60 years old (58% women) from single-channel electrocardiograms recorded 1968-1971. We examined the association of PWI and long-term outcomes using Cox proportional hazards models incorporating age, sex, body mass index, systolic blood pressure, treatment for hypertension, significant murmur, and PR interval.
Results: Over median follow-up of 15.8 years (range 0-38.7 years), 359 participants developed AF and 1525 died. The multivariable-adjusted hazard ratio (HR) per standard deviation (SD) increase in maximum P wave duration was 1.04 (95% Confidence Interval [CI] 0.92-1.17, p=0.08) for AF and 1.02 (95% CI 0.96-1.08, p=0.18) for mortality. When stratified at the 95th percentile, the upper 5% of P wave maximum duration had a multivariable-adjusted HR of1.65 (95% CI 1.08-2.53, p=0.002) for AF and a HR of 1.11 (95% CI 0.87-1.40, p=0.20) for mortality. The Figure depicts the unadjusted cumulative incidence curves for (a) AF and (b) mortality, stratified at the 95th percentile. We found no significant associations between P wave dispersion and AF or mortality.
Conclusions: Maximum P wave duration at the upper fifth percentile is associated with long-term AF risk in an elderly, community-based cohort. P wave duration is an endophenotype for AF and warrants assessment in longitudinal risk prediction models.
- © 2010 by American Heart Association, Inc.